Mohammed T. Abou-Saleh

414 PRINCIPLES AND PRACTICE OF GERIATRIC PSYCHIATRYCases ofdepression( n = 120)Year 3 Year 5AGECATCases( n = 43)AGECATNon-cases( n = 36)Dropouts( = 16) n16991298AGECATCases( n = 25)AGECATNon-cases( n = 21)Dropouts( = 17) nconditions, social support, physical illness, depression type (DPand DN), depression score and psychiatric co-morbidity) werepredictive of a poor outcome for the depression cases that hadsurvived. Anxiety caseness and a depression score of 30 wereparticularly predictive of a poor outcome in this sample. Thoseaged under 75 years did better than those 75 years and older.A prospective follow-up of the cases of depressive disorders atshorter intervals is the strength of this study. Its findings highlightthe importance of the mental health needs of this population.Further studies are needed to discover whether drug treatments orother psychosocial interventions can alleviate depression in elderlypeople living in the community.Organicity and Outcome of the Cases of DepressionIn all, 30 (25%) of the 120 cases of depression had co-morbidorganic symptoms (AGECAT levels 1–2) at the index assessment.By year 5, nine (30%) had died and seven (23%) had dropped out.Of the remaining 14, 12 (40%) were AGECAT cases and two werenon-cases. Seven (6%) of the 120 cases of depression (15% of thesurviving cases) had become organic cases at the 5 year follow-up.Five of them had already had some organic symptoms (AGECATlevels 1 or 2) at the start of the study.Predictors of OutcomeDead( = 25) nDead( = 16) nFigure 1 Outcome of the cases of depression (from ref. 34, withpermission)Sub-cases ofdepression( n = 47)AGECATCases( n = 16)AGECATNon-cases( n = 27)Dropouts( = 4) nUnivariate analyses were done to see which index variables (age,gender, marital status, social class, stressful events, living97Year 3 Year 5223145566AGECATCases( n = 4)AGECATNon-cases( n = 17)Dropouts( = 10) nDead( = 12) nFigure 2 Outcome of the subcases of depression (from ref. 34, withpermission).REFERENCES1. Blazer DG. Epidemiology. In Blazer DG, ed., Depression in Late Life.St. Louis, MO: C.V. Mosby, 1982; 103–17.2. Eastwood MR, Corbin SL. The epidemiology of mental disorders inold age. In Arie THD, ed., Recent Advances in Psychogeriatrics.London: Churchill Livingstone, 1985; 17–32.3. Copeland JRM, Dewey ME, Wood N et al. Range of mental illnessamong the elderly in the community: prevalence in Liverpool usingthe GMS–AGECAT package. Br J Psychiat 1987; 150: 815–23.4. Kay DWK, Henderson AS, Scott R et al. Dementia and depressionamong the elderly living in the Hobart community: the effect of thediagnostic criteria on the prevalence rates. Psychol Med 1985; 15:771–88.5. Livingston G, Hawkins A, Graham N et al. The Gospel Oak Study:prevalence rates of dementia, depression and activity limitationamong elderly residents in Inner London. Psychol Med 1990; 20: 137–46.6. Lindesay J, Briggs K, Murphy E. The Guys’/Age Concern Survey,prevalence rates of cognitive impairment depression and anxiety in anurban elderly community. Br J Psychiat 1989; 155: 317–29.7. Ben-Arie O, Swartz L, Dickman BJ. Depression in the elderly living inthe community. Its presentation and features. Br J Psychiat 1987; 150:169–74.8. Saunders PA, Copeland JR, Dewey ME et al. The prevalence ofdementia, depression and neurosis in later life: the Liverpool MRC-ALPHA Study. Int J Epidemiol 1993; 22(5): 838–47.9. Kirby M, Bruce I, Radic A et al. Mental disorders among thecommunity-dwelling elderly in Dublin. Br J Psychiat 1997; 171: 369–72.10. Ben-Arie O, Welman M, Teggin AF. The depressed elderly living inthe community—a follow-up study. Br J Psychiat 1990; 157: 425–7.11. Kivela SL, Kongas-Saviaro P, Kesti E et al. Five-year prognosis fordepression in old age. Int Psychogeriat 1994; 6(1): 69–78.12. Beekman ATF, Deeg DJH, Smit JH, Tilburg WV. Predicting thecourse of depression in the older population: results from acommunity based study in The Netherlands. J Affect Disord 1995;34: 41–9.13. Copeland JRM, Davidson IA, Dewey ME et al. Alzheimer’s disease,other dementias, depression and pseudodementia prevalence:incidence and three year outcome in Liverpool: GMS–HASAGECAT. Br J Psychiat 1992; 161: 230–9.14. Kua EH. The depressed elderly Chinese living in the community: afive-year follow-up study. Int J Geriat Psychiat 1993; 8: 427–30.15. Prince MJ, Harwood RH, Thomas A, Mann AH. A prospectivepopulation-based cohort study of the effects of disablement and socialmilieu on the onset and maintenance of late-life depression. TheGospel Oak Project VII. Psychol Med 1998; 28: 337–50.16. Henderson AS, Korten AE, Jacomb PA et al. The course ofdepression in the elderly: a longitudinal community-based study inAustralia. Psychol Med 1997; 27(1): 119–29.17. Livingston G, Manela M, Katona C. Cost of community care forolder people. Br J Psychiat 1997; 171: 56–9.18. Pulska T, Pahkala K, Laippala P, Kivela SL. Six-year survival ofdepressed elderly Finns: a community study. Int J Geriat Psychiat1997; 12(9): 942–50.